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The burden of cardiovascular disease on our communities

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Most of us want to live longer, healthier lives. But while we are living longer, many are doing so in poor health and stubborn inequalities persist, particularly around cardiovascular disease (CVD), where those from our most deprived communities are at greatest risk. CVD creates a huge burden for individuals, their families, and communities, affecting seven million people and costing the country as a whole over £15bn each year.

Alongside traditional risk factors such as smoking, obesity, and high blood pressure, there are a wide range of social determinants that affect our risk of developing CVD, such as where we live, our education and income status. Local authorities have a vital role to play in supporting prevention to boost the local economy and lower future demand on health and social care settings.

Support stop smoking services: Smoking is a major cause of CVD and evidence shows that the best way to quit is with a combination of behaviour support and stop smoking aids. Ensuring there is evidence-based support available for smokers to access is an important part of local action to reduce smoking rates and associated inequalities. Local authorities can use PHE’s fingertips tool to identify priority populations and there are some great examples of local success models: see Essex County Council’s work with selected e-cigarette stores to deliver stop smoking support to customers.

Support community mobilisation: Consider targeted campaigns that help people to understand CVD risk factors such as blood pressure. These are a number of areas where this approach has been effective, such as the Bradford Healthy Hearts initiative. The British Heart Foundation has also just launched a new initiative to improve diagnosis of high blood pressure across local communities by offering checks at pharmacies, barber shops, and train stations, with the view to scaling successful approaches across the UK.

Promote NHS Health Checks: The NHS Health Check helps people to find out their risk of conditions like CVD and get support to lower this risk. Each local authority has a statutory responsibility to offer this vital check and evidence shows that it is effective in reaching deprived populations and other high-risk groups, so it has real potential to address local health inequalities.

Building healthier environments: Local authorities play a crucial role in creating healthier environments that offer people improved choices and chances for a healthier life and there is growing evidence for how this can be done well. Using the Healthy New Towns guidance and following the ten principles for putting health into place can help plan interventions that can make the biggest difference to local health outcomes, whether by clinical, lifestyle or community support.

Plan secondary prevention: Effective CVD prevention relies on planning the right use of secondary interventions, like blood pressure and cholesterol medication. PHE has a number of tools to help local authorities and public health teams do this. Our most recent Return on Investment tool helps commissioners plan effectively by showing the local benefits of secondary approaches to preventing CVD. Our Prioritisation Framework and Spend and Outcome Tool also help to inform transparent, evidence-based spending decisions across public health programmes and have been used successfully in regions such as Durham and Shropshire.

There is currently a 19-year gap in healthy life expectancy between the most and least deprived areas of England, for both men and women. With commissioning landscapes now moving towards the integration of health and care commissioning and services, there is a tremendous opportunity to put people first, designing and delivering services which meet their needs. Stepping up our efforts to prevent CVD is a national priority and a joint approach with local authorities will help us ensure that more people live healthier longer lives.

By Professor Jamie Waterall, National Lead for Cardiovascular Disease Prevention, Public Health England

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